Central nervous system tumor: Difference between revisions
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{{Adult top}} [[Central nervous system tumor (peds)]].'' | |||
==Background== | ==Background== | ||
*Metastatic tumors more common than primary CNS in adults | *Metastatic tumors more common than primary CNS in adults | ||
| Line 29: | Line 30: | ||
==Evaluation== | ==Evaluation== | ||
*[[CT head]] | *[[CT head]] | ||
*MRI required for small tumors or areas not well visualized on CT (e.g. posterior fossa) | *[[brain MRI|MRI]] required for small tumors or areas not well visualized on CT (e.g. posterior fossa) | ||
*Evaluate for other causes of symptoms (i.e. [[stroke]], metabolic derangement, [[ICH]]) | *Evaluate for other causes of symptoms (i.e. [[stroke]], metabolic derangement, [[ICH]]) | ||
Latest revision as of 22:16, 11 November 2020
This page is for adult patients. For pediatric patients, see: Central nervous system tumor (peds).
Background
- Metastatic tumors more common than primary CNS in adults
- CNS tumors are second most common pediatric cancer, leading cause of cancer-related death in children
- Most primary tumors in children are infratentorial, whereas most infratentorial masses in adults are metastases
Clinical Features
- Depend on location and size of tumor
- Focal neuro deficits
- Cranial nerve palsies
- Behavioral changes, psychosis
- Focal weakness
- Focal sensory deficits
- Abnormal reflexes
- Endocrinopathies (craniopharyngiomas and other suprasellar tumors)
- Bowel/bladder dysfunction
- Features of elevated ICP (from cerebral edema, tumor bleed, or mass effect
- Headache (from increased pressure on heavily innervated meninges)
- Red flags: worse in the morning, worse with valsalva, wakes from sleep, daily
- Nausea/vomiting
- Also typically worse in the morning
- Papilledema, dilated optic nerve
- Cushing's triad: Bradycardia, hypertension, irregular respirations
- Bulging fontanelle in infants
- Headache (from increased pressure on heavily innervated meninges)
- Seizure
- Altered mental status, irritability, coma
Differential Diagnosis
Evaluation
- CT head
- MRI required for small tumors or areas not well visualized on CT (e.g. posterior fossa)
- Evaluate for other causes of symptoms (i.e. stroke, metabolic derangement, ICH)
Management
- See elevated ICP
- Corticosteroids (reduce tumor capillary permeability, inflammatory cytotoxicity)
- Dexamethasone 10-20mg IV, followed by 4mg IV q6h
- Elevate head of bed to 30 degrees, provide adequate sedation in intubated patients
- Maintain cerebral perfusion (euvolemia, vasopressors if necessary)
- Consider osmotherapy (e.g. hypertonic saline, mannitol)
- Corticosteroids (reduce tumor capillary permeability, inflammatory cytotoxicity)
- Treat seizure with benzodiazepines +/- AEDs, prophylactic AEDs are not recommended
- Consult neurosurgery
Disposition
See Also
- Cerebral edema in brain cancer
- Elevated ICP
- Brain herniation syndromes
- Oncologic emergencies
- Seizure, Seizure (peds)
- Headache, Headache (peds)
- CNS tumors (peds)